In any case, before thinking about surgery, it is imperative to consult with a physician that will direct you to a medical specialist (angiologist, cardiologist, vascular surgeon) that will perform an echo-doppler examination.
ANESTHESIA
The procedure is done local anesthesia most of the time, and sometimes under general
WHAT ARE THE MODALITIES REGARDING THE SURGERY?
The main procedure is the femoropopliteal bypass.
The goal is to give the blood a shortcut using a tube to avoid going through the diseased artery.
This procedure requires a minimum of 2 incisions: the first one near the groin allows to connect the prosthesis or the vein to be connected to the femoral artery, the second incision, located above or below the knee, is used for the anastomosis around the popliteal artery.
In the case of venous bypasses, several additional incisions on the thigh are usually necessary to tie up the branches of the vein.
The hospitalization length varies between 5 to 10 days. This surgery requires longer hospital stays compared to dilation because of the time required for scars to heal.
Post operative care is limited to bandages and subcutaneous injections of blood thinners.
After the surgery, an antiplatelet treatment is started.
After the surgery, you will be given a post surgery examination by the surgeon, and a echo-doppler exam by your specialist physician.
The other common procedure is the endarterectomy: removal of the atheroma plaque clogging the artery.
WHAT MATERIALS ARE USED IN THIS PROCEDURE?
- prosthesis in Dacron or PTFE (Poly-Tétra-Fluoro-Ethylène)
- Your own superficial saphenous vein. This is called an autograft. The vein is used to replace the artery.
RESULTS
- usualy the result is good with a permeability of the by-pass
- Thrombosis (obstructed bypass) can occur either right after the procedure, either during the stay in the hospital. Usually the result of a technical problem (inferior quality of the vein, or a receiving artery that is too damaged) and requires another procedure immediately. When a new bypass is not technically possible, the arterite can get even worse with the occurrence of insufferable pains and gangrene that will require an amputation.
- long term results : results are usually satisfying average permeability of 70% after 5 years, given a frequent monitoring by your physician in order to track down possible progressive breakdowns of the connecting spots between the bypass and the arteries.
WHAT INCIDENTS MIGHT OCCUR ?
Despite all the care we give our patients, incidents or accidents can occur and be identified and treated immediately. These might be:
- Hematomas arise from the use of blood thinners and the frequent rises in blood pressure. This usually results in painful swellings. Can require a surgical intervention if serious.
- Hemorrhaging after injury to the artery or the vein. Blood transfusion is still extremely rare for that kind of procedure.
- Nervous lesions: In most cases these lesions are responsible for temporary disorders. Touching the sensitive femoral nerves happens frequently and results in areas on insensitivity or electric shock-like pain in the anterior and internal side of the thigh. The pain usually doesn’t last long but the insensitivity can last several months.
- Anesthesia accidents. Those are extremely rare. More specific information will be provided to you during the preoperative consult.
- Lymphatic complications are noticed near the groin. It can either be a lymph effusion (lymphorrhoea) or a simple swelling called lyphocele. This will not go away spontaneously and it may be necessary to operate to tie the responsible lymphatic vessels.
- Thrombosis and pulmonary embolism are extremely rare and are constantly prevented during the surgery (blood thinners, ...)
- Infections are more frequent if a bypass is done to treat a wound or an early gangrene. It can be either deep or superficial. Especially dangerous in case of a prosthetic bypass, it would then require another procedure to remove the prosthesis and perform a venous bypass.
Arteritis of the inferior limbs
Surgery
Marc FITOUSSI M.D.
18-22 Queen Anne Street
W1G 8HU London
+44 20 7034 3326
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